<?php
$chooseAttrib = array('good' => 'good', 'fair' => 'fair', 'limited' => 'limited', 'none' => 'none' );
$genderAttrib = array('' => 'Select Gender...', 'male' => 'Male', 'female' => 'Female' );
$citizAttrib = array('Filipino' => 'Filipino', 'Chinese' => 'Chinese', 'North Korean' => 'North Korean', 'South Korean' => 'South Korean', 'US Citizen' => 'US Citizen', 'other' => 'Other' );
$citizComp = array(
'Afghan' =>'Afghan',
'Albanian'=>'Albanian',
'Algerian'=>'Algerian',
'Andorran'=>'Andorran',
'Angolan'=>'Angolan',
'Argentinian'=>'Argentinian',
'Armenian'=>'Armenian',
'Australian'=>'Australian',
'Austrian'=>'Austrian',
'Bahamian'=>'Bahamian',
'Bahraini'=>'Bahraini',
'Bangladeshi'=>'Bangladeshi',
'Barbadian'=>'Barbadian',
'Belarusian,Belarusan'=>'Belarusian,Belarusan',
'Belgian'=>'Belgian',
'Belizean'=>'Belizean',
'Beninese'=>'Beninese',
'Bhutanese'=>'Bhutanese',
'Bolivian'=>'Bolivian',
'Bosnian'=>'Bosnian',
'Botswanan,Tswana'=>'Botswanan,Tswana',
'Brazilian'=>'Brazilian',
'British,Briton'=>'British,Briton',
'Bruneian'=>'Bruneian',
'Bulgarian'=>'Bulgarian',
'Burkinese'=>'Burkinese',
'Burmese'=>'Burmese',
'Burundian'=>'Burundian',
'Cambodian'=>'Cambodian',
'Cameroonian'=>'Cameroonian',
'Canadian'=>'Canadian',
'Cape Verdean'=>'Verdean',
'Chadian'=>'Chadian',
'Chilean'=>'Chilean',
'Colombian'=>'Colombian',
'Congolese'=>'Congolese',
'Costa Rican'=>'Costa Rican',
'Croat,Croatian'=>'Croat,Croatian',
'Cuban'=>'Cuban',
'Cypriot'=>'Cypriot',
'Czech'=>'Czech',
'Danish,Dane'=>'Danish,Dane',
'Djiboutian'=>'Djiboutian',
'Dominican'=>'Dominican',
'Dutch'=>'Dutch',
'Ecuadorean'=>'Ecuadorean',
'Egyptian'=>'Egyptian',
'Salvadorean'=>'Salvadorean',
'English'=>'English',
'Eritrean'=>'Eritrean',
'Estonian'=>'Estonian',
'Ethiopian'=>'Ethiopian',
'Fijian'=>'Fijian',
'Finn'=>'Finn',
'French'=>'French',
'Gabonese'=>'Gabonese',
'Gambian'=>'Gambian',
'Georgian'=>'Georgian',
'German'=>'German',
'Ghanaian'=>'Ghanaian',
'Greek'=>'Greek',
'Grenadian'=>'Grenadian',
'Guatemalan'=>'Guatemalan',
'Guinean'=>'Guinean',
'Guyanese'=>'Guyanese',
'Haitian'=>'Haitian',
'Honduran'=>'Honduran',
'Hungarian'=>'Hungarian',
'Icelander'=>'Icelander',
'Indian'=>'Indian',
'Indonesian'=>'Indonesian',
'Iranian'=>'Iranian',
'Iraqi'=>'Iraqi',
'Irish'=>'Irish',
'Italian'=>'Italian',
'Jamaican'=>'Jamaican',
'Japanese'=>'Japanese',
'Jordanian'=>'Jordanian',
'Kazakh'=>'Kazakh',
'Kenyan'=>'Kenyan',
'Kuwaiti'=>'Kuwaiti',
'Laotian'=>'Laotian',
'Latvian'=>'Latvian',
'Lebanese'=>'Lebanese',
'Liberian'=>'Liberian',
'Libyan'=>'Libyan',
'Liechtensteiner'=>'Liechtensteiner',
'Lithuanian'=>'Lithuanian',
'Luxembourger'=>'Luxembourger',
'Macedonian'=>'Macedonian',
'Malagasy,Madagascan'=>'Malagasy,Madagascan',
'Malawian'=>'Malawian',
'Malaysian'=>'Malaysian',
'Maldivian'=>'Maldivian',
'Malian'=>'Malian',
'Maltese'=>'Maltese',
'Mauritanian'=>'Mauritanian',
'Mauritian'=>'Mauritian',
'Mexican'=>'Mexican',
'Moldovan'=>'Moldovan',
'Monegasque,Monacan'=>'Monegasque,Monacan',
'Mongolian'=>'Mongolian',
'Montenegrin'=>'Montenegrin',
'Moroccan'=>'Moroccan',
'Mozambican'=>'Mozambican',
'Namibian'=>'Namibian',
'Nepalese'=>'Nepalese',
'New Zealander'=>'New Zealander',
'Nicaraguan'=>'Nicaraguan',
'Nigerien'=>'Nigerien',
'Nigerian'=>'Nigerian',
'Norwegian'=>'Norwegian',
'Omani'=>'Omani',
'Pakistani'=>'Pakistani',
'Panamanian'=>'Panamanian',
'Papua New Guinean,Guinean'=>'Papua New Guinean,Guinean',
'Paraguayan'=>'Paraguayan',
'Peruvian'=>'Peruvian',
'Pole'=>'Pole',
'Portuguese'=>'Portuguese',
'Qatari'=>'Qatari',
'Romanian'=>'Romanian',
'Russian'=>'Russian',
'Rwandan'=>'Rwandan',
'Saudi Arabian,Saudi'=>'Saudi Arabian,Saudi',
'Scot'=>'Scot',
'Senegalese'=>'Senegalese',
'Serb,Serbian'=>'Serb,Serbian',
'Seychellois'=>'Seychellois',
'Sierra Leonian'=>'Sierra Leonian',
'Singaporean'=>'Singaporean',
'Slovak'=>'Slovak',
'Slovene,Slovenian'=>'Slovene,Slovenian',
'Solomon Islander'=>'Solomon Islander',
'Somali'=>'Somali',
'South African'=>'South African',
'Spaniard'=>'Spaniard',
'Sri Lankan'=>'Sri Lankan',
'Sudanese'=>'Sudanese',
'Surinamer,Surinamese'=>'Surinamer,Surinamese',
'Swazi'=>'Swazi',
'Swedish,Swede'=>'Swedish,Swede',
'Swiss'=>'Swiss',
'Syrian'=>'Syrian',
'Taiwanese'=>'Taiwanese',
'Tajik/Tadjik'=>'Tajik/Tadjik',
'TaTanzanian'=>'TaTanzanian',
'Thai'=>'Thai',
'Togolese'=>'Togolese',
'Trinidadian'=>'Trinidadian',
'Tobagan/Tobagonian'=>'Tobagan/Tobagonian',
'Tunisian'=>'Tunisian',
'Turk'=>'Turk',
'Turkmen'=>'Turkmen',
'Tuvaluan'=>'Tuvaluan',
'Ugandan'=>'Ugandan',
'Ukrainian'=>'Ukrainian',
'Emirati'=>'Emirati',
'Uruguayan'=>'Uruguayan',
'Uzbek'=>'Uzbek',
'Vanuatuan'=>'Vanuatuan',
'Venezuelan'=>'Venezuelan',
'Vietnamese'=>'Vietnamese',
'a Welshman, a Welshwoman'=>'a Welshman, a Welshwoman',
'Western Samoan'=>'Western Samoan',
'Yemeni'=>'Yemeni',
'Yugoslav'=>'Yugoslav',
'Zairean'=>'Zairean',
'Zambian'=>'Zambian',
'Zimbabwean'=>'Zimbabwean'
);
?>

<div>&nbsp;</div>

	<div class="large-12 columns"><h5 class="lead">APPLICANT INFORMATION (List all names as recorded in birth certificate/passport)</h5></div>
	
	<hr class="clearfix">
	<div class="large-4 columns">
		<span>Student Number</span>
		<?='<br>'.form_error('student_number');?>
		<input type="text" name="student_number" value="<?=set_value('student_number');?>">
	</div>
	<div class="clearfix"></div>
	
	<div class="large-4 columns">
		<span>Valid Email Address</span>
		<?='<br>'.form_error('email');?>
		<input type="email" data-tooltip class="has-tip tip-top" title="Student information, credentials and other news will be sent to your email address." name="email" value="<?=set_value('email');?>">
	</div>
	<div class="large-4 columns">
		<span>Grade Level</span>
		<?='<br>'.form_error('level_id');?>
		<?php echo form_dropdown('level_id', $levels, set_value('level_id'));?>
	</div>
	<div class="clearfix"></div>
	
	<div class="large-4 columns">
		<span>First Name</span>
		<?='<br>'.form_error('child_fname');?>
		<input type="text" name="child_fname" value="<?=set_value('child_fname');?>">
	</div>
	<div class="large-4 columns">
		<span>Middle Name</span>
		<?php echo '<br>'.form_error('child_mname') == '' ? '<span style="font-size:10px;font-weight:bold;">If No middle name just put "none"</span>' : '<br>'.form_error('child_mname'); ?>
		<input type="text" name="child_mname" value="<?=set_value('child_mname');?>">
	</div>
	<div class="large-4 columns">
		<span>Last Name</span>
		<?='<br>'.form_error('child_lname');?>
		<input type="text" name="child_lname" value="<?=set_value('child_lname');?>">
	</div>
	<div class="large-4 columns">
		<span>Preferred Name</span>
		<?='<br>'.form_error('child_nickname');?>
		<input type="text" name="child_nickname" value="<?=set_value('child_nickname');?>">
	</div>
	<div class="large-4 columns">
		<span>Name Ext (e.g jr,II,III)</span>
		<?='<br>'.form_error('child_name_ext');?>
		<input type="text" name="child_name_ext" value="<?=set_value('child_name_ext');?>">
	</div>
	<div class="large-4 columns">
		<span>Gender</span>
		<?='<br>'.form_error('gender');?>
		<?=form_dropdown('gender', $genderAttrib, set_value('gender'));?>
	</div>
	<div class="clearfix"></div>
	<div class="large-4 columns">
		<span>Date of Birth:</span>
		<?='<br>'.form_error('child_bdate');?>
		<input type="text" name="child_bdate" class="birthdate" value="<?=set_value('child_bdate');?>">
	</div>
	<div class="large-4 columns">
		<span>Citizenship (Passport)</span>
		<?='<br>'.form_error('child_nationality');?>
		<?php echo form_dropdown('child_nationality', $citizAttrib, set_value('child_nationality'), 'id="child_nationality"');?>
	</div>
	<div class="large-4 columns">
		<span>Place of Birth</span>
		<?='<br>'.form_error('child_placeofbirth');?>
		<input type="text" name="child_placeofbirth" value="<?=set_value('child_placeofbirth');?>">
	</div>
	<div id="for_other_nationality" style="display:none;">
	<div class="clearfix"></div>
	<div class="large-4 columns"><span>&nbsp;</span></div>
	<div class="large-4 columns">
		<?php //echo form_dropdown('child_nationality2', $citizComp, set_value('child_nationality2'), 'id="child_nationality2"');?>
		<?='<br>'.form_error('child_nationality2');?>
		<input type="text" name="child_nationality2" value="<?=set_value('child_nationality2');?>">
	</div>
	<div class="large-4 columns"><span>&nbsp;</span></div>
	</div>
	
	<div class="clearfix"></div>
	<div  class="large-12 columns">
		<span>Residential Address in the Philippines</span>
		<?='<br>'.form_error('child_city_address');?>
		<input type="text" name="child_city_address" value="<?=set_value('child_city_address');?>">
	</div>
	<div class="clearfix"></div>
	<div class="large-4 columns">
		<span>Home Phone</span>
		<?='<br>'.form_error('child_telno');?>
		<input type="text" name="child_telno" value="<?=set_value('child_telno');?>">
	</div>
	<div class="large-4 columns">
		<span>Mobile Phone</span>
		<?='<br>'.form_error('mobile_phone');?>
		<input type="text" name="mobile_phone" value="<?=set_value('mobile_phone');?>">
	</div>
	<div class="large-4 columns">
		<span>Religion</span>
		<?='<br>'.form_error('child_religous');?>
		<input type="text" name="child_religous" value="<?=set_value('child_religous');?>">
	</div>
	<div class="clearfix"></div>
	
	<div class="large-12 columns">
		<span>1- The student will be living in the Philippines with (pls. check all that apply):</span>
		<?php echo $cannot_be_with=='no' ? '<br><span class="error_simple">Please choose at least 1.</span>' : ''; ?>
	</div>
	
	<div class="row">
		<div class="large-12 columns">
			<div class="large-4 columns">
				<?=form_checkbox('living_in_ph_with_father', 'yes', set_checkbox('living_in_ph_with_father', 'yes'));?>
				<span>Father / Step Father</span>
			</div>
			<div class="large-4 columns">
				<?=form_checkbox('living_in_ph_with_mother', 'yes', set_checkbox('living_in_ph_with_mother', 'yes'));?>
				<span>Mother / Step Mother</span>
			</div>
			<div class="large-4 columns">&nbsp;</div>
		</div>
	</div>
	
	<div class="row">
		<div class="large-12 columns">
		<div class="large-2 columns">
			<?=form_checkbox('living_in_ph_with_guardian', 'yes', set_checkbox('living_in_ph_with_guardian', 'yes'), 'id="living_in_ph_with_guardian"');?>
			<span>Guardian</span>
		</div>
		<div class="large-10 columns">&nbsp;</div>
		</div>
	</div>
	
	<div class="clearfix"></div>
	
	<div id="legal_guardian_info">
	<div class="large-12 columns">
		<span>Information about the legal guardian</span>
	</div>
	
	<div class="row" >
		<div class="large-12 columns">
			<div class="large-4 columns">
				<span>Guardian's First Name</span>
				<?='<br>'.form_error('guardian_name');?>
				<input type="text" name="guardian_name" value="<?=set_value('guardian_name');?>">
			</div>
			<div class="large-4 columns">
				<span>Guardian's Middle Name</span>
				<?='<br>'.form_error('guardian_mname');?>
				<input type="text" name="guardian_mname" value="<?=set_value('guardian_mname');?>">
			</div>
			<div class="large-4 columns">
				<span>Guardian's Last Name</span>
				<?='<br>'.form_error('guardian_lname');?>
				<input type="text" name="guardian_lname" value="<?=set_value('guardian_lname');?>">
			</div>
			<div class="clearfix"></div>
			<div class="large-4 columns">
				<span>Citizenship (Passport)</span>
				<?='<br>'.form_error('guardian_citizenship');?>
				<input type="text" name="guardian_citizenship" value="<?=set_value('guardian_citizenship');?>">
			</div>
			<div class="large-4 columns">
				<span>Philippine Visa Status</span>
				<?='<br>'.form_error('guardian_visa');?>
				<input type="text" name="guardian_visa" value="<?=set_value('guardian_visa');?>">
			</div>
			<div class="clearfix"></div>
			<div class="large-4 columns">
				<span>Employer or Organization</span>
				<?='<br>'.form_error('guardian_occup');?>
				<input type="text" name="guardian_occup" value="<?=set_value('guardian_occup');?>">
			</div>
			<div class="large-4 columns">
				<span>Office Phone Number</span>
				<?='<br>'.form_error('guardian_office_tel');?>
				<input type="text" name="guardian_office_tel" value="<?=set_value('guardian_office_tel');?>">
			</div>
			<div class="large-4 columns">
				<span>Mobile Number</span>
				<?='<br>'.form_error('guardian_contact_no');?>
				<input type="text" name="guardian_contact_no" value="<?=set_value('guardian_contact_no');?>">
			</div>
			<div class="clearfix"></div>
			<div class="large-12 columns">
				<label><?=form_checkbox('guardian_contact_no_text', 'yes', FALSE, set_checkbox('guardian_contact_no_text', 'yes'));?>&nbsp;<span>Would you like to receive text messages about upcoming events, activities and other school announcements on your mobile number?</span></label>
			</div>
		</div>
	</div>
	</div>
	
	<div class="large-12 columns">
		<div class="large-4 columns" style="padding:0px;">
			<span>2- Your child's English reading and writing level: </span>
			<?='<br>'.form_error('childs_english_reading_writing_level');?>
		</div>
		<div class="large-2 columns">
			<?=form_dropdown('childs_english_reading_writing_level', $chooseAttrib, set_value('childs_english_reading_writing_level'));?>
		</div>
		

		<div class="large-4 columns" style="padding:0px;">
			<span>3- Your child's English verbal proficiency: </span>
			<?='<br>'.form_error('childs_english_verbal_proficiency');?>
		</div>
		<div class="large-2 columns">
			<?=form_dropdown('childs_english_verbal_proficiency', $chooseAttrib, set_value('childs_english_verbal_proficiency'));?>
		</div>
		
	</div>
	
	<div class="large-12 columns">
		<span>4- Languages Spoken at home?</span>
		<?='<br>'.form_error('language_at_home');?>
		<input type="text" name="language_at_home" value="<?=set_value('language_at_home');?>">
	</div>
	
	<div class="large-12 columns">
		<span>5- List any participation in advanced level classes (i.e., Advanced Math, Gifted or Talented, Gateway, Writing, etc.)</span>
		<?='<br>'.form_error('participation_in_advanced_level_classes');?>
		<input type="text" name="participation_in_advanced_level_classes" value="<?=set_value('participation_in_advanced_level_classes');?>">
	</div>
	
	<div class="large-12 columns">
		<span>6- Did your child receive any remedial help in previous schools (i.e., Remedial Program, Special Education, Speech Therapy, IEP, IDP, etc). <br/>If yes, please explain and provide latest testing results.</span>
		<?='<br>'.form_error('remedial_help_in_previous_schools');?>
		<input type="text" name="remedial_help_in_previous_schools" value="<?=set_value('remedial_help_in_previous_schools');?>">
	</div>
	
	<div class="large-12 columns">
		<span>7- Does your child have any special talent or interest in:</span>
	</div>
	
	<div class="row">
		<div class="large-12 columns">
			<div class="large-2 columns">
				<?=form_checkbox('special_talent_interest_dance', 'yes');?>
				<span>Dance</span>
			</div>
			<div class="large-2 columns">
				<?=form_checkbox('special_talent_interest_drama', 'yes');?>
				<span>Drama</span>
			</div>
			<div class="large-2 columns">
				<?=form_checkbox('special_talent_interest_art', 'yes');?>
				<span>Art</span>
			</div>
			<div class="large-2 columns">
				<?=form_checkbox('special_talent_interest_acomputer', 'yes');?>
				<span>Computer</span>
			</div>
			<div class="large-3 columns">
				<?=form_checkbox('special_talent_interest_vocal_chorus', 'yes');?>
				<span>Vocal or Chorus</span>
			</div>
			<div class="large-1 columns">&nbsp;</div>
		</div>
	</div>
	<br>
	<div class="row">
		<div class="large-12 columns">
			<div class="large-4 columns">
				<?=form_checkbox('special_talent_interest_athletics', 'yes');?>
				<span>Athletics - favorite Sport(s):</span>
			</div>
			<div class="large-8 columns">
				<?='<br>'.form_error('special_talent_interest_athletics_spec');?>
				<input type="text" name="special_talent_interest_athletics_spec" value="<?=set_value('special_talent_interest_athletics_spec');?>">
			</div>
		</div>
	</div>
	<div class="row">
		<div class="large-12 columns">
			<div class="large-4 columns">
				<?=form_checkbox('special_talent_interest_band', 'yes');?>
				<span>Band (Instrument?)</span>
			</div>
			<div class="large-8 columns">
				<?='<br>'.form_error('special_talent_interest_band_spec');?>
				<input type="text" name="special_talent_interest_band_spec" value="<?=set_value('special_talent_interest_band_spec');?>">
			</div>
		</div>
	</div>
	<div class="row">
		<div class="large-12 columns">
			<div class="large-4 columns">
				<?=form_checkbox('special_talent_interest_string', 'yes');?>
				<span>String (Instrument?)</span>
			</div>
			<div class="large-8 columns">
				<?='<br>'.form_error('special_talent_interest_string_spec');?>
				<input type="text" name="special_talent_interest_string_spec" value="<?=set_value('special_talent_interest_string_spec');?>">
			</div>
		</div>
	</div>
	
	<div class="large-12 columns">
		<span>8- Is there any other information you think the teacher should know about your child?</span>
		<?='<br>'.form_error('hinder_childs_learning');?>
		<textarea name="hinder_childs_learning"><?=set_value('hinder_childs_learning');?></textarea>
	</div>
	
	<div class="large-12 columns">
		<span>9- Has your child ever been asked to leave school because of any behavioral / disciplinary problems? If yes, please explain.</span>
		<?='<br>'.form_error('leave_school');?>
		<textarea name="leave_school"><?=set_value('leave_school');?></textarea>
	</div>
	
	<div class="large-12 columns">
		<label class="span">Name of Previous School:</label> 
		<?='<br>'.form_error('previous_school');?>
		<input type="text" name="previous_school" value="<?=set_value('previous_school');?>">
	</div>
	<div class="large-12 columns">
		<label class="span">Complete School Address (including zip code):</label>
		<?='<br>'.form_error('previous_school_address');?>
		<input type="text" name="previous_school_address" value="<?=set_value('previous_school_address');?>">
	</div>
	<div class="large-12 columns">
		<label class="span">Grade Level / Academic Year</label> 
		<?='<br>'.form_error('previous_grade_level');?>
		<input type="text" name="previous_grade_level" value="<?=set_value('previous_grade_level');?>">
	</div>
	
	<hr class="clearfix">
	
	<div>
		<a href="#" id="panel_1" class="btn btn-primary">Continue Part 2: Parent / Legal Guardian Information</a>
	</div>
	
<script>
$( document ).ready(function() {

	$('#panel_1').on('click', function(event) {
		$('#panel1').removeClass("active");
		$('#panel1').css("padding-top", "");
		$('#panel2').addClass("active");
		$('#panel3').removeClass("active");
		$('#panel3').css("padding-top", "");
		$('#panel4').removeClass("active");
		$('#panel4').css("padding-top", "");
	});
	
});
</script>